Poll Finds Bipartisan Public Support For Creating State Insurance Exchanges Despite Continuing Party Divisions Over the ACA

More Americans Back Than Oppose State Medicaid Expansions But, Like Many Governors, Public Splits Along Party Lines

On The Federal Deficit, Public Wants Action But Still Resists Most Cuts and Sacrifices, Especially to Medicare

A majority of Americans put the creation of state-based health insurance exchanges at the top of the priority list for health policy in their state this year, according to a survey released today by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Fifty-five percent of the public, including majorities of Republicans and Democrats, say that establishing the exchanges – a key element of the Affordable Care Act (ACA) and one whose implementation has divided states along partisan political lines – is a “top priority” for their governor and legislature. So far 18 states and the District of Columbia have declared that they will create their own state-based exchanges, seven other states have opted to establish exchanges in partnership with the federal government and 25 others – some driven by resistance to the ACA – appear set to default to a federally-run exchange.

“Governors are largely splitting along partisan lines on the exchanges, but the public is not. People like the idea,” said Drew Altman, President and CEO of the Kaiser Family Foundation.

Similarly, while some Republican governors are balking at the optional expansion of Medicaid under the ACA, more Americans (52%) say their state should expand its Medicaid program than not (42%). But on Medicaid views differ sharply by party, with two-thirds of Republicans saying they prefer to keep their state Medicaid program as is (66%) and 3 in 4 Democrats (75%) seeking a state expansion. Independents are evenly divided.

In the bigger picture, the survey finds just over half of Americans (52%) – including 78 percent of Republicans – agree that opponents of the ACA should continue trying to change it so that the law has “less impact on taxpayers, employers, and health care providers”, while 40 percent agree that “those opposed to the health care law should accept that it is now the law of the land and stop trying to block [its] implementation”.

Meanwhile, policymakers involved in budget deficit negotiations at the federal level face a familiar conundrum. Even as most Americans (65%) say that Washington should act quickly to bring down the deficit, there is little public appetite for major reductions in federal spending on health care. Overall, six in ten (58%) oppose any spending cuts to Medicare and 46 percent oppose any cuts to Medicaid. When it comes to which federal activities should be subject to “major” cuts, there is only majority agreement on reducing foreign aid and funding for the conflict in Afghanistan.

Only two of six specific proposals asked about in the poll to trim Medicare draw majority support from the public. They would require drug companies to give the federal government a better deal on medications for low-income people on Medicare, and require high income seniors to pay higher Medicare premiums – backed by 85 percent and 59 percent of the public, respectively. In contrast, 51 percent oppose gradually raising the age of eligibility for Medicare from 65 to 67, an idea currently making the rounds in Washington. And 61 percent “strongly oppose” requiring all seniors to pay higher Medicare premiums. The poll also found a widespread view among the public that cuts to Medicare are not really needed; the public believes that there are other, better ways to reduce the deficit.

Americans were also asked to identify from a list of 15 federal program areas in health and health care (excluding Medicare, Medicaid and the ACA) which ones they considered to be “one of the top priorities” for federal spending this year, even in the context of the budget deficit. Five were cited by a majority of the public: funding for veterans’ health care (60%); dealing with health problems resulting from natural or man-made disasters (59%); increasing research to find new cures and treatments for major disease threats (58%); preventing the spread of infectious diseases, including providing vaccinations (52%); and preventing chronic illnesses, such as heart disease, cancer, and diabetes (51%).

“In a climate heavily focused on reducing the federal budget deficit, the public still places a high priority on federal spending on veterans’ health care, medical research, health-related responses to disasters, and preventing chronic and infectious diseases,” said Robert Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Asked about the diseases or health conditions that pose the greatest threats to the American public, the public’s top concerns are cancer (56%) and heart disease (35%), as has been true for several years. But since 2007, there has been a substantial increase in the proportion of the public that see diabetes (30% in 2013, compared to 14% in 2007) and obesity (26% in 2013, compared to 6% in 2007) as posing one of the two greatest threats.

“These poll results provide more evidence that our nation is on the right track with expanding availability of affordable health coverage, and focusing more on preventing illness before it results in costly treatment,” said David Colby, Vice President for Public Policy at the Robert Wood Johnson Foundation.

Methodology

This Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health survey, The Public’s Health Care Agenda for the 113th Congress, was designed and analyzed by public opinion researchers at the Kaiser Family Foundation led by Mollyann Brodie, Ph.D., including Claudia Deane, Bianca DiJulio, Sarah Cho, and Theresa Boston, by Debra Perez, Ph.D., Katherine Hempstead, Ph.D. and David Colby, Ph.D at the Robert Wood Johnson Foundation, and by Professor Robert Blendon, Sc.D., John Benson, and Mandy Brulé at the Harvard School of Public Health. The survey was conducted January 3 through January 9, 2013, among a nationally representative random sample of 1,347 adults ages 18 and older. Telephone interviews conducted by landline (807) and cell phone (540, including 253 who had no landline telephone) were carried out in English and Spanish by Social Science Research Solutions. Both the landline and cell phone samples were generated through Marketing Systems Group’s GENESYS sampling system. The margin of sampling error including the design effect is plus or minus 3 percentage points. For results based on other subgroups, the margin of sampling error may be higher.

The full question wording, results, charts and a brief on the poll can be viewed online. A webcast of today’s Washington briefing where the survey was released will be available online later today.

The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school, visit http://www.hsph.harvard.edu.